HomeMy WebLinkAboutBuilding permit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building,PermitApplication
Planning'and Development Services
Building and Code.Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ... _
Phone: (7-72)462-1553_.Fax:.(772)462-1578 _ Commercial....... . _. ._- ._ _. .Residential �C
I
PERMIT TYPE:
PROPOSED IMPROVEMENT L CATION;'
Address: 5 Ao' ✓ /
Pro ert ax. D#: d .O.
O O / N
Site Plan Name: lock No.
Project Name:
n ¢ + i .:a
DETAILED'DESC'RIPTI.OSNOE: WORK x _ �
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CO STRUCTI0 INFORMATION «:
Additional work to be,performed under this permit4-check all that apply:
_Mechanical; ._ —.-Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric - _Plumbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor.
Cost of Construct'io'n:$ 1 ®(;� Utilities: _Sewer'" Septic Building-Height:
`OWNER/LESSEE. 'CONTRACTOR:
Name Q Name:
Address: Company: n.: .
City: Stater Address:
Zip Code: Fax: City: State:
Phone No. - .0. -_C � 9 Zip-Code: Fax:
E-Mail: bdnit.711 ,a! .S'M4� `/ •ed.0-7 Phone.No%.
Fill in fee simple Title Holder on next,page(if dlfferent._;' 'E-Mail
from the Owner listed above) 'State or County License
If value of construction is$2500 or,more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. -
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SURRL,EMENTALCQNSTR'UCT10N LIENyIAW INFORMATION `_
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: - Not-Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip:. .. , Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: __Not.Applicable.
Name: Name:
Address: Address:
City: i City:
Zip-: Phone: Zip:, Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work-and Installation as Indicated.
I certify that no work or installation has commenced prior to the issuance of a permit ^
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable,Home Owners Association rules;bylaws or and.covenants that may restrict or prohibit such+.,
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In considerationiof'the granting of this-requested-permit,I do hereby agree-that 1-will,in all-respects,perform the work '
in accordance with the approved plans,the Florida Building Codes and St,Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structuress swimming-pools;fences;--walls,signs,screen rooms and accessory uses to another non-residential'use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY..RESULT,* YOUR.PAYING
TWICE IMP YEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT'.MUST"BE`RECORDED AND
OS
0014 J B SITE.'BEFORE THE•FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
H YO D -OR-Ati,XftORNEY BEFORE RECORDING YOUR NOTICE-OF COMMENCEMENT:" - -
Si nature oIF
L ee/Co tr ctor as Agent for_Owner. . - Signature of Contractor/License_Holder,
_STA ORIDA _ . f STATE OF FLORIDA``
COUNTY Ll( C`.1 COUNTY OF
The f i rumpwas acknowledgAg,d'�`�before me" ` ' The'forgoin`g'instrument was acknowledged before me
th' f.:„. 2QLC�by.; thin;:-s --day of ti. _:-; ,20_ by.-. - ,
N ieo erson making statement Name of person making statement.
PersonVIy'Known, OR Produced;Identification Personall Known ORProduced Identification
Ty
pe-of Identification ' " Type of Identification
Produced ;�(, (JL _ Produced _...
(Signature-of No1-ary
I�s e,o cLrL N-VAU G H'N' (Signature of Notary Public State of Florida)
;=0 4�.State of Florida-Notary,
P:u61ic
- Com n#GG 270079Commisslon No. a = rrrr�� qp Commission No. (Seal)
o, OFFIOP�` My Comriiission Expires.
__. •,,nwr `0ct-0b&22, 2022 -
REVIEWS __ ..:_FRONT- _ZONING- -SUPERVISOR PLANS VEGETA71ON SEA TURTLE .N.IANG,RiOVE '
COUNTER REVIEW REVIEW,.,, :REVIEW w=RMI EW ' 'REVIEW?. Jii=VJE�(
DATE
-1 717
DATE _. --
COMPLETED
ev. 17119 ;, . . .,...